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Weinmann, Robert

Dr. Robert Weinmann, past president of the Union of American Physicians and Dentists, L 206 of AFSCME, AFL-CIO, has a private neurology practice in San Jose. He has testified numerous times in the California legislature and in Congress about healthcare, Medicare, and antitrust reform. At the invitation of former President Bill Clinton, he was featured as a speaker at the White House on managed care reform. He claims his public policy agitation is bipartisan.

SB 923 (DELEON) is reportedly devised to correct a payment gap to primary treating physicians (PTPs). This bill would mandate increased pay for PTPs by lowering payments currently made to specialists and by redistributing the money to the PTPs. It would accomplish this task by replacing the current Office Medical Fee Schedule with a Medicare fee schedule. However, careful reading of the bill does not show that the bill would be obliged to increase PTP reimbursement.

SB 923 (De Leon) is before the Assembly Appropriations Committee. SB 923 would replace the current Office Medical Fee Schedule (OMFS) that’s now used to pay the primary treating physicians (PTPs) and specialists who take care of injured workers in California. The OMFS would be replaced by the Medicare RBRVS system. The Medicare RBRVS is advantageous to primary treating physicians because it would raise their payment rates. The bill is sponsored by USHealthWorks which is divided into a management group which includes non-physicians as owners and a medical group which includes the PTPs. The bill would lower payments to specialists.

In 2008, Governor Schwarzenegger vetoed AB 2969 (Lieber) which would have required doctors who do Utilization Review (UR) for injured workers in California to be licensed to practice medicine in California. UR is the technique insurance companies use to authorize or disallow diagnostic testing and treatment to injured workers even if the diagnostic testing and treatment has already been prescribed by a doctor licensed to practice medicine in California. Got that? Insurance companies are allowed to retain contractors to do UR and who under the law are allowed to deny injured workers access to diagnostic tests and treatment that has been prescribed by your duly licensed California doctor (in workers comp terminology, your treating doctor is known as the PTP or Primary Treating Physician).